Concierge self pay medicine (also known as
direct primary care) is a relationship between a patient and a primary
care in which the patient pays an annual fee or
retainer. This may or may not be in addition to other charges.
In exchange for the retainer. Other terms in use include boutique medicine, retainer-based
medicine, and innovative medical design.

This is also referred to as membership medicine, concierge
health care, family doctors, primary care, direct
primary care, and direct medicine.

All generally claim to be accessible via cell phone or email at
any time of day or night or offer some other "special" service
above and beyond the normal primary care provided. The annual fees
vary widely, from $600 to $5,000 per year for an individual,
with the lower annual fees being in addition to the usual fees
for each service and the higher annual fees including most
services.
COD = self pay they talk about his aches
and pains, his heart problems and his diet, but never about his
health insurance.

When O'Brien leaves the exam room, he writes a check for $50 and
he's done — no forms, no ID numbers, no copayments.

"This is traditional medicine. This is what America was like 30
years ago," said O'Brien, 55 and self-employed, who believes he
has saved thousands of dollars by dropping his expensive
insurance policy. "self pay it's a whole world of
difference."

Is this the healthcare wave of the future? Probably not, experts
say. Most people are content with monthly premiums and $10
copays; nine out of 10 contract with managed treatment
companies.

For the 43 million Americans who lack health insurance is a fact of life when a trip to the
pharmacy cannot be avoided.

Even when treating patients who are insured, -
frustrated by red tape at the insurance companies - view
medicine as an increasingly attractive way to run
their businesses.

"It's a terrible indictment of the collapsing healthcare
system," said Arthur Caplan, chairman of the medical ethics
department at the University of Pennsylvania Medical School.
"Insurance and managed were supposed to streamline - instead
what they've done is add so much paperwork and bureaucracy
they're driving some out."

"I don't look at it as a threat," said Mohit Ghose, spokesman
for the industry group America's Health Insurance Plans. "It's
just a different way of practicing."

Medical establishment leaders don't object to working for simple
cash.

"This is America. self pay," said Dr. John C.
Nelson, president-elect of the American Medical Association.

An obstetrician-gynecologist in Salt Lake City, Nelson easily
recalled times when he believed managed rules prevented his
patients from getting the best treatment. He said are driven by the desire to practice medicine without
interference.

"There is a great intrusion by third parties into the
patient-physician relationship," Nelson said. "We can understand
their frustration."

self pay,

Before self pay, he charged $79 for an office visit
and got $43 from an insurance company months later, minus the
$20 in staff time it took to collect the payment. Now he charges
$50 — and he never worries about collection costs, because
patients pay in full after every visit.

self pay sees fewer patients now. His whole office would
probably fit inside his old waiting room. But he says the
freedom is worth it.

Marietta Family

He started a group called SimpleCare to spread the gospel only medicine. The organization steers patients who offer discounts, and gives technical and
moral support to those who want to start cutting their ties to
insurance. Membership has grown to 22,000 patient members and
1,500. Some reject all insurance and take only,
while others continue to accept insurance while offering
discounts of 15 percent to 50 percent for paying
patients.

Independent of SimpleCare in California, Colorado,
Minnesota, Texas, Mississippi and other states have also quit
the insurance game. Some tired of the paperwork and
administrative expenses. Some wanted to spend more time with
patients without managed treatment bean-counters peering over
their shoulders. The patients who pay range from poor to
wealthy, with most in the blue-collar middle.

"When I first started, I thought it would be the elite. That's
not the case," said Dr. Shelley Giebel, an
obstetrician-gynecologist in Temple, Texas, who washed her hands
of insurance eight years ago.

Her standard, hour-long annual checkup costs $140. Everyone
pays.

If a patient needs extra tests or treatment, Giebel tells them
upfront what it will cost.

"If it is an urgent care test, we'll go ahead and do it. We're not
going to delay medical treatment because they don't have the
money in hand," she said. Often, patients return later with the
money.

"It has usually not been a problem that people forgo medical
treatment," she said.

The movement isn't just changing the way people pay,
it's changing the way they work. Because of managed
treatment's low reimbursement rates on insurance
contracts must limit their time with each patient.

Giebel, a typical example, said she would have to double her
patient load to make ends meet if she relied on insurance —
something she can't imagine. "How can you possibly talk about
prevention of cancer and heart disease when you're seeing
patients every 12 minutes?" she asked.

Patients rave about the quality of attention.

"They take time here with you," said Jesse Rainwater, a
59-year-old church pastor from Bellevue, Wash., who credits
Cherewatenko with teaching him to manage his diabetes. "They
don't just bring you in and run you out like a bunch of cattle.
You feel like you're loved."

The approach evokes Norman Rockwell-tinged visions
of being paid with chickens. The simplicity is
tempting, but the truth is many people went without preventive
health treatment in those "good old days." A $50 charge can be
powerful incentive to delay seeing until you're in pain
— which can lead to more expensive health problems later.

"Medicine used to be a business, and there were
certainly many people who didn't have the cash," said Caplan,
the medical ethicist. who insist on also have an
ethical obligation to help people who can't afford the fee, he
said — even if it means accepting chickens.

crusaders acknowledge the need for some type of
insurance. Without it, expensive surgery or hospitalization
would force most people into bankruptcy. But they think health
insurance should work more like car insurance: you pay for the
routine maintenance and little dings yourself, and insurance
pays for more expensive repairs.

O'Brien, a freelance marketing specialist, switched from a
comprehensive health plan with $300 monthly premiums to a
catastrophic plan that costs $75 a month, with a $2,000
deductible. He pays out-of-pocket for routine checkups, and his
insurance will kick in if he ever needs expensive treatment.

The promise of a simple payment lured him to Cherewatenko's ga office, but the doctor's personal attention
keeps him coming back. The $50 exams are just part of the
bargain for O'Brien. Cherewatenko recently met him for coffee to
talk about improving his diet — including an admonition to cut
back on caffeine.

"How often does go out and have a cup of coffee with
you?" O'Brien asked.